{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T03:41:51Z","timestamp":1776310911895,"version":"3.50.1"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T00:00:00Z","timestamp":1713398400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T00:00:00Z","timestamp":1713398400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["JA Clin Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Given the advances in medicine, women with Fontan circulation are now reaching childbearing age. However, data on the mode of delivery and anesthetic management of these patients are limited. We report the cases of five pregnant women with Fontan circulation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>The mean age at delivery was 28\u2009\u00b1\u20093\u00a0years, and the mean gestational period was 34\u00a0weeks and 3\u00a0days. Anticoagulation therapy was switched from warfarin and aspirin to continuous intravenous heparin. The modes of delivery were scheduled cesarean section (C\/S) in one, emergency C\/S in three, and vaginal delivery with epidural labor analgesia in one patient. Three patients underwent C\/S under regional anesthesia; one received general anesthesia. The perinatal complications were heart failure, worsening valve regurgitation, and postoperative hematoma in three, four, and two patients, respectively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>For C\/S in women with Fontan circulation, regional anesthesia should be considered. Epidural labor analgesia can help prevent the decrease in pulmonary blood flow due to straining. We initiated labor analgesia or C\/S with regional anesthesia at the appropriate time in four patients.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40981-024-00706-3","type":"journal-article","created":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T13:02:50Z","timestamp":1713445370000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Anesthetic management in pregnant women with Fontan circulation: a case series"],"prefix":"10.1186","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9315-1679","authenticated-orcid":false,"given":"Ai","family":"Fujita","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuhiro","family":"Shirozu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Midoriko","family":"Higashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken","family":"Yamaura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,4,18]]},"reference":[{"key":"706_CR1","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1136\/heartjnl-2015-307467","volume":"102","author":"M Gewillig","year":"2016","unstructured":"Gewillig M, Brown SC. The Fontan circulation after 45 years: update in physiology. Heart. 2016;102:1081\u20136.","journal-title":"Heart"},{"key":"706_CR2","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1136\/heartjnl-2015-308788","volume":"102","author":"M Cauldwell","year":"2016","unstructured":"Cauldwell M, Von Klemperer K, Uebing A, Swan L, Steer PJ, Babu-Narayan SV, et al. A cohort study of women with a Fontan circulation undergoing preconception counselling. Heart. 2016;102:534.","journal-title":"Heart"},{"key":"706_CR3","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.ijcard.2015.03.344","volume":"187","author":"M Gouton","year":"2015","unstructured":"Gouton M, Nizard J, Patel M, Sassolas F, Jimenez M, Radojevic J, et al. Maternal and fetal outcomes of pregnancy with Fontan circulation: a multicentric observational study. Int J Cardiol. 2015;187:84\u20139.","journal-title":"Int J Cardiol"},{"key":"706_CR4","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.ijoa.2016.08.004","volume":"28","author":"RS Monteiro","year":"2016","unstructured":"Monteiro RS, Dob DP, Cauldwell MR, Gatzoulis MA. Anaesthetic management of parturients with univentricular congenital heart disease and the Fontan operation. Int J Obstet Anesth. 2016;28:83\u201391.","journal-title":"Int J Obstet Anesth"},{"key":"706_CR5","doi-asserted-by":"publisher","first-page":"103210","DOI":"10.1016\/j.ijoa.2021.103210","volume":"48","author":"M McCabe","year":"2021","unstructured":"McCabe M, An N, Aboulhosn J, Schwarzenberger J, Canobbio M, Vallera C, et al. Anesthetic management for the peripartum care of women with Fontan physiology. Int J Obstet Anesth. 2021;48:103210.","journal-title":"Int J Obstet Anesth"},{"key":"706_CR6","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1053\/j.jvca.2022.07.009","volume":"37","author":"DE Clark","year":"2023","unstructured":"Clark DE, Staudt G, Byrne RD, Jelly C, Christian K, Dumas SD, et al. Case series conference: anesthetic management in parturients with Fontan physiology. J Cardiothorac Vasc Anesth. 2023;37:167\u201376.","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"706_CR7","doi-asserted-by":"publisher","first-page":"3147","DOI":"10.1093\/eurheartj\/ehr218","volume":"32","author":"V Regitz-Zagrosek","year":"2011","unstructured":"Endorsed by the European Society of Gynecology (ESG), the Association for European Paediatric Cardiology (AEPC), the German Society for Gender Medicine (DGesGM), Authors\/Task Force Members, Regitz-Zagrosek V, BlomstromLundqvist C, Borghi C, Cifkova R, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Euro Heart J. 2011;32:3147\u201397.","journal-title":"Euro Heart J"},{"key":"706_CR8","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1177\/1753495X17737680","volume":"11","author":"E Moroney","year":"2018","unstructured":"Moroney E, Posma E, Dennis A, d\u2019Udekem Y, Cordina R, Zentner D. Pregnancy in a woman with a Fontan circulation: a review. Obstet Med. 2018;11:6\u201311.","journal-title":"Obstet Med"},{"key":"706_CR9","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1136\/heartjnl-2014-306497","volume":"101","author":"TPE Ruys","year":"2015","unstructured":"Ruys TPE, Roos-Hesselink JW, Pijuan-Dom\u00e8nech A, Vasario E, Gaisin IR, Iung B, et al. Is a planned caesarean section in women with cardiac disease beneficial? Heart. 2015;101:530\u20136.","journal-title":"Heart"},{"key":"706_CR10","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1002\/uog.8936","volume":"38","author":"M Kuleva","year":"2011","unstructured":"Kuleva M, Youssef A, Maroni E, Contro E, Pilu G, Rizzo N, et al. Maternal cardiac function in normal twin pregnancy: a longitudinal study. Ultrasound Obstet Gynecol. 2011;38:575\u201380.","journal-title":"Ultrasound Obstet Gynecol"},{"key":"706_CR11","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1016\/j.thromres.2004.08.004","volume":"114","author":"B Brenner","year":"2004","unstructured":"Brenner B. Haemostatic changes in pregnancy. Thromb Res. 2004;114:409\u201314.","journal-title":"Thromb Res"}],"container-title":["JA Clinical Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40981-024-00706-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40981-024-00706-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40981-024-00706-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T13:05:47Z","timestamp":1713445547000},"score":1,"resource":{"primary":{"URL":"https:\/\/jaclinicalreports.springeropen.com\/articles\/10.1186\/s40981-024-00706-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,18]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["706"],"URL":"https:\/\/doi.org\/10.1186\/s40981-024-00706-3","relation":{},"ISSN":["2363-9024"],"issn-type":[{"value":"2363-9024","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,18]]},"assertion":[{"value":"27 January 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 March 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 April 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 April 2024","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"25"}}